As hard as they come

Nicotine dependence is comparable with addiction to drugs like heroin, says a report which calls for a Nicotine Regulatory Authority. Barbara Millar reports

More than two-thirds of smokers in Britain say they would like to quit and about one-third try to give up in any given year. Yet only about 2 per cent succeed.

The reason most fail is that they are addicted to the nicotine in cigarettes and, according to a report by the Royal College of Phy-sicians, the addiction to nicotine is comparable with addiction to 'hard' drugs such as heroin and cocaine.

'Recognition of nicotine addiction's central role is important, ' says RCP president Professor George Alberti.

'It has major implications for the way smoking is managed by doctors and other health professionals, and for the way in which harmful nicotine delivery products such as cigarettes should be regulated and controlled.'

Clive Bates, director of Action on Smoking and Health, agrees. 'Society should wake up and recognise that it has a deadly and pervasive addictive-drug syndrome covering a quarter of the adult population and we should stop pretending that cigarettes are just some innocuous or quirky lifestyle habit, ' he says.

The RCP report calls on GPs to regard it as a core function to treat nicotine addiction just as much as alcohol dependence or illicit drug addiction. It wants to see hospitals and other health service providers required to offer 'appropriate cessation support' to all smokers.

Nicotine replacement therapy is available on the NHS - for just one week to people on low incomes who live in health action zones.

The RCP wants the therapy, which it calls 'a highly effective and cost-effective treatment', to be available to all smokers, for about six weeks, through reimbursable NHS prescriptions, at a cost to the service of between£40m and£100m a year.

The RCP also wants to see a change to the 'simplistic and misleading' way tar and nicotine in cigarettes are measured, warning labels on tobacco products altered and words such as 'light' and 'mild' banned.

Jean King, director of education for the Cancer Research Campaign, agrees that the words 'light' and 'mild' in cigarette advertising have fooled a lot of people into thinking they are doing something less harmful by smoking them.

Mr Bates believes the RCP report will 'sound the death knell' for low-tar cigarettes and the comforting, but wrong, idea that these are somehow less dangerous.

But Professor Gerard Hastings, director of the centre for tobacco control at Strathclyde University, does not agree. 'Smokers don't realise what they are getting into. They are victims of an industry that is completely ruthless.

'The word 'light' may be banned, but what about colouring? Silk Cut picks its colours very successfully to reassure the public that its product is gentle and safe. Tobacco manufacturers are extremely sophisticated.'

The vast majority of regular smokers begin in adolescence and, by the time they are smoking on a daily basis, they are inhaling a similar dose of nicotine per cigarette to adult smokers, says the RCP report.

But pro-smoking pressure group Forest says the RCP's call for tobacco products to be regulated by a Nicotine Regulatory Authority is an example of 'the nanny state gone mad and one step from prohibition'.

'There is nothing in tobacco products that prevents consumers from giving up smoking if they wish, ' says Forest campaign director Martin Bell.

'In the UK over 11 million adults have been able to quit and more are doing so every day. Comparing nicotine to heroin shows how desperate the antismoking industry has become.

'What the anti-smokers cannot accept is that a great many smokers enjoy smoking and get a great deal of pleasure from it. It has nothing to do with addiction.'

Not so, says Martin Jarvis, professor of health psychology at University College London, one of the report's authors. 'The dimension of nicotine that really stands out is the grip it has on its users, ' says Professor Jarvis. 'It is probably harder to give up smoking than it is to give up any other form of drug abuse.'

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